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Three-Dimensional Anorectal Manometry Enhances Diagnostic Gain by Detecting Sphincter Defects and Puborectalis Pressure

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Abstract

Background

Constipation and fecal incontinence (FI) are common and are often evaluated with anorectal manometry. Three-dimensional high-resolution anorectal manometry (HRAM) is a promising technology; however, implementation has been limited by lack of metrics and unclear clinical utility.

Aim

To investigate the diagnostic utility of 3D HRAM compared to 2D HRAM.

Methods

Three-dimensional HRAM studies performed from April 2012 to October 2013 were identified and re-interpreted by two blinded investigators examining 3D function. Disagreements were resolved by a third investigator. Puborectalis (PR) visualization, focal defects, and dyssynergy were reported. Differences between groups were analyzed with Fisher’s exact test. Discordance was analyzed with McNemar Chi-square test.

Results

Two hundred and twenty-one 3D HRAM studies were identified. Mean age and BMI were 52.2 ± 17.4 and 27.1 ± 7.5 years (81% female, 74% white). Most common indications for 3D HRAM were constipation (65%) and FI (28%). PR function was visualized in 81% (rest), 97% (squeeze), and 73% (strain). PR was visualized less often at rest in FI than constipation (68 vs. 85%, p = 0.007). Defects were identified twice as often in FI than constipation (19 vs. 10%, p = 0.113). Twenty-nine defects (86% anterior) were visualized on 3D HRAM. Inter-reader agreement was moderate for PR function (κ = 0.471), but fair for focal defects (κ = 0.304).

Conclusions

PR function and focal defects can be visualized on 3D-HRAM with added diagnostic benefit compared to 2D. Fair inter-reader agreement for focal defects highlights the need for quantitative metrics.

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Author’s contribution

SR contributed to acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and statistical analysis. FCO, SD, and EMS contributed to acquisition of data, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. MN and KLL contributed to acquisition of data and critical revision of the manuscript for important intellectual content. CPG helped in study design and concept, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. JOC helped in study design and concept, acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, and study supervision.

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Correspondence to John O. Clarke.

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The authors of this article have no financial, professional or personal conflicts of interests to report.

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Raja, S., Okeke, F.C., Stein, E.M. et al. Three-Dimensional Anorectal Manometry Enhances Diagnostic Gain by Detecting Sphincter Defects and Puborectalis Pressure. Dig Dis Sci 62, 3536–3541 (2017). https://doi.org/10.1007/s10620-017-4466-5

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  • DOI: https://doi.org/10.1007/s10620-017-4466-5

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